Left atrial deformation as a potent predictor for paroxysmal atrial fibrillation in patients with end-stage renal disease

Abstract

It is widely known that various factors contribute to left atrial (LA) mechanical dysfunction in patients with end stage renal disease (ESRD). However, the connection between atrial dysfunction and arrhythmic events such as paroxysmal atrial fibrillation (PAF), in this group of patients, remains unclear. The purpose of our study was to evaluate prospectively the association between LA deformation indices and PAF in ESRD patients. 79 patients (41 men, mean age 57 ± 17) with ESRD and preserved left ventricular systolic function comprised the study population. All patients underwent a baseline comprehensive echocardiography study and were followed for a mean period of 16 ± 5 months. PAF episodes, first and the following events, were reported. LA longitudinal strain reflecting LA reservoir function and LA longitudinal strain rate reflecting LA pump function were specifically evaluated as LA deformation indices of interest, using 2D speckle tracking echocardiography. At the end of follow up period nine patients died. 15 of the rest 70 reported one or more episodes of PAF. LA indexed volumes were significantly higher in patients with PAF (32 ± 26 vs. 21.5 ± 9 ml/m, p = 0.002), mean LA strain was significantly reduced (17 ± 7 vs. 27 ± 9%, p < 0.001) as well as mean LA stain rate (- 1.19 ± 0.5 vs. - 1.95 ± 0.5 1/s, p < 0.001). Multivariate analysis showed that LA strain rate when adjusted with age together with PAF history remained the single most significant echocardiographic parameter for PAF prediction. Impaired LA strain and LA strain rate are associated with PAF in ESRD patients. LA strain rate might be a better independent predictor of PAF, compared to standard echocardiographic indices. Further prospective studies are needed to validate its relevance in routine clinical practice.

Left atrial strain is associated with adverse cardiovascular events in patients with end‐stage renal disease: Findings from the Cardiac, Endothelial Function and Arterial Stiffness in ESRD (CERES) study

“…25 Papadopoulos et al demonstrated in 79 ESRD patients that LA reservoir strain predicted paroxysmal atrial fibrillation. 26 A recent study of patients with pre-dialysis chronic kidney disease (CKD) Stages 3/4 by Gan et al showed that LA reservoir strain was a very good predictor F I G U R E 3 Subgroup analyses for the primary outcome showed that albumin, dichotomized as the median serum albumin (3.6 g/dl), was a significant interaction term for the association of left atrial (LA) reservoir strain with the primary outcome (AUC 0.84) for MACE and overall death, and its association with the composite outcome was significant after adjustment for comorbidities and echocardiographic parameters. 27 To our knowledge, we are the first to characterize LA volume, LA reservoir strain, LA conduit strain, and LA booster strain in an ESRD cohort with adjudicated MACE.…”

“…Tsai et al report that LA strain was associated with overall and CV mortality in unadjusted analyses 25 . Papadopoulos et al demonstrated in 79 ESRD patients that LA reservoir strain predicted paroxysmal atrial fibrillation 26 . A recent study of patients with pre‐dialysis chronic kidney disease (CKD) Stages 3/4 by Gan et al showed that LA reservoir strain was a very good predictor (AUC 0.84) for MACE and overall death, and its association with the composite outcome was significant after adjustment for comorbidities and echocardiographic parameters 27 .…”

Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging

“…However, the connection between atrial dysfunction and arrhythmic events such as paroxysmal atrial fibrillation, in this group of patients, remains unclear. Papadopoulos et al prospectively evaluated the association between left atrial deformation indices and paroxysmal atrial fibrillation in 79 patients with end stage renal disease and preserved left ventricular systolic function [40]. All patients underwent a baseline comprehensive echocardiography study and were followed for a mean period of 16 ± 5 months.…”